Developing mental health care capacity in postearthquake Haiti is hampered by the lack of assessments that include culturally bound idioms Haitians use when discussing emotional distress. The current paper describes a novel emic-etic approach to developing a depression screening for Partners in Health/Zanmi Lasante. In Study 1 Haitian key informants were asked to classify symptoms and describe categories within a pool of symptoms of common mental disorders. Study 2 tested the symptom set that best approximated depression in a sample of depressed and not depressed Haitians in order to select items for the screening tool. The resulting 13-item instrument produced scores with high internal reliability that were sensitive to culturally informed diagnoses, and interpretations with construct and concurrent validity (vis-à-vis functional impairment). Discussion focuses on the appropriate use of this tool and integrating emic perspectives into developing psychological assessments globally. The screening tool is provided as an Appendix.
AbboC.OkelloE.EkbladS.WaakoP.MusisiS. (2008) Lay concepts of psychosis in Busoga, Eastern Uganda: A pilot study. World Cultural Psychiatry Research Review3(3): 132–145.
2.
American Psychiatric Association (2000) Diagnostic and statistical manual, (4th ed., Text revision. Washington, DC: American Psychiatric Association.
3.
American Psychiatric Association (2013) Diagnostic and statistical manual, (5th ed. Washington, DC: American Psychiatric Association.
4.
AvotriJ.WaltersV. (1999) “You just look at our work and see if you have any freedom on earth”: Ghanaian women's accounts of their work and their health. Social Science & Medicine48: 1123–1133.
5.
BeckA. T.SteerR. A. (1990) Manual for the Beck Anxiety Inventory, San Antonio, TX: Psychological Corporation.
6.
BelkinG. S.UnützerJ.KesslerR. C.VerdeliH.RaviolaG. J.SachsK.EustacheE. (2011) Scaling up for the “bottom billion”: “5 × 5” implementation of community mental health care in low-income regions. Psychiatric Services62(12): 1494–1502.
7.
BernardH. R. (2005) Research methods in anthropology: Qualitative and quantitative approaches, Lanham, MD: AltaMira Press.
8.
BetancourtT.BoltonP.BassJ. (2007, November) Promoting mental health resilience in war-affected youth: Implementing interventions, Symposium presented at the 22nd Annual Meeting of the International Society of Traumatic Stress Studies, Hollywood, CA.
9.
BetancourtT. S.Rubin-SmithJ. E.BeardsleeW. R.StulacS. N.FayidaI.SafrenS. (2011) Understanding locally, culturally, and contextually relevant mental health problems among Rwandan children and adolescents affected by HIV/AIDS. AIDS Care23(4): 401–412.
10.
BoltonP.NeugebauerR.NdogoniL. (2002) Prevalence of depression in rural Rwanda based on symptom and functional criteria. Journal of Nervous and Mental Disease190(9): 631–637.
11.
BoltonP.SurkanP. J.GrayA. E.DesmousseauxM. (2012) The mental health and psychosocial effects of organized violence: A qualitative study in northern Haiti. Transcultural Psychiatry49. , 590–612.
12.
BoltonP.TangA. M. (2004) Using ethnographic methods in the selection of post disaster, mental health interventions. Prehospital Disaster Medicine19(1): 97–101.
13.
BoltonP.WilkC.NdogoniL. (2004) Assessment of depression prevalence in rural Uganda using symptom and function criteria. Social Psychiatry and Psychiatric Epidemiology39: 442–447.
14.
BrodwinP. (1996) Medicine and morality in Haiti: The contest for healing power, Cambridge, UK: Cambridge University Press.
15.
BudosanB.BrunoR. F. (2011) Strategy for providing integrated mental health/psychosocial support in post earthquake Haiti. Intervention9(3): 225–236.
16.
CarrazanaE.DeToledoJ.TatumW.Rivas-VasquezR.ReyG.WheelerS. (1999) Epilepsy and religious experiences: Voodoo possession. Epilepsia40(2): 239–241.
17.
CerdáM.PaczkowskiM.GaleaS.NemethyK.PéanC.DesvarieuxM. (2013) Psychopathology in the aftermath of the Haiti earthquake: A population-based study of posttraumatic stress disorder and major depression. Depression and Anxiety30: 413–424.
18.
CohenJ. (1988) Statistical power analysis for the behavioral sciences, Hillsdale, NJ: Lawrence Erlbaum Associates.
19.
DeconinckH. (2003) The health condition of spinal cord injuries in two Afghan towns. Spinal Cord41: 303–309.
20.
DerogatisL. R.MelisaratosN. (1983) The Brief Symptom Inventory: An introductory report. Psychological Medicine13: 595–605.
21.
DesrosiersA.St FleuroseS. (2002) Treating Haitian patients: Key cultural aspects. American Journal of Psychotherapy56(4): 508–521.
22.
FarmerP. (1992) The birth of the klinik: A cultural history of Haitian professional psychiatry. In: GainesA. (ed) Ethnopsychiatry: The cultural construction of professional and folk psychiatries, Albany, NY: SUNY Press, pp. 251–272.
23.
FentonS.Sadiq-SangsterA. (1996) Culture, relativism and the expression of mental distress: South Asian women in Britain. Sociology of Health and Illness18(1): 66–85.
24.
FullardB. (2012, May) Reflechi twop (thinking too much): Description of a novel cultural syndrome in Haiti's Central Plateau, Presentation at the Annual Meeting of the Society for the Study of Psychiatry and Culture. New York.
25.
GalloJ. J.AnthonyJ. C.MuthenB. O. (1994) Age differences in the symptoms of depression: A latent trait analysis. Journal of Gerontology49(6): 251–264.
26.
GhassemzadehH.MojtabaiR.KaramghadiriN.EbrahimkhaniN. (2005) Psychometric properties of a Persian-language version of the Beck Depression Inventory-second edition: BDI-II-PERSIAN. Depression and Anxiety21(4): 185–192.
27.
HammenC.BrennanP. A.Keenan-MillerD. (2008) Patterns of adolescent depression to age 20: The role of maternal depression and youth interpersonal dysfunction. Journal of Abnormal Child Psychology36(8): 1189–1198.
28.
HandwerkerW. P. (2001) Quick ethnography, Lanham, MD: AltaMira Press.
29.
HillelJ.DesrosiersP.TurnierL. (1994) La dépression chez l'Haïtien [Depression in Haitians]. Médecin du Québec29(2): 121–123.
30.
HintonW. L.DuN.ChenY. C.TranC. G.NewmanT. B.LuF. G. (1994) Screening for major depression in Vietnamese refugees: A validation and comparison of two instruments in a health screening population. Journal of General Internal Medicine9: 202–206.
31.
HintonD. E.HintonA. L.EngK.-T.ChoungS. (2012) PTSD and key somatic complaints and cultural syndromes among rural Cambodians: The results of a needs assessment survey. Medical Anthropology Quarterly26(3): 383–407.
32.
KaiserB. N.KohrtB. A.KeysH. M.KhouryN. M.BrewsterA. R. T. (2013) Strategies for assessing mental health in Haiti: Local instrument development and transcultural translation. Transcultural Psychiatry50(4): 532–558.
33.
KaraszA. (2005) Cultural differences in conceptual models of depression. Social Science & Medicine60(7): 1625–1635.
34.
KesslerR. C.BirnbaumH.BrometE.HwangI.SampsonN.ShahlyV. (2010) Age differences in major depression: Results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine40(2): 225–237.
35.
KeysH. M.KaiserB. N.KohrtB. A.KhouryN. M.BrewsterA. R. (2012) Idioms of distress, ethnopsychology, and the clinical encounter in Haiti's Central Plateau. Social Science & Medicine75(3): 555–564.
36.
KhortB. A.JordansM. J. D.TolW. A.SpeckmanR. A.MaharjanS. M.WorthmanC. M.KomproeI. H. (2008) Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. Journal of the American Medical Association300(6): 691–702.
37.
KhouryN. M.FullardB. N.BrewsterA.-R. T.KeysH. N.KohrtB. A. (2012) Explanatory models and mental health treatment: Is vodou an obstacle to psychiatric treatment in rural Haiti?Culture, Medicine, and Psychiatry36(3): 514–534.
38.
KievA. (1961) Folk psychiatry in Haiti. Journal of Nervous and Mental Disease132(3): 260–265.
39.
KleinmanA. (1977) Depression, somatization and the “new cross-cultural psychiatry.”. Social Science & Medicine11(1): 3–9.
40.
KleinmanA. (1991) Rethinking psychiatry, New York, NY: Free Press.
41.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2001) The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine16(9): 606–613.
42.
LhewaD.BanuS.RosenfeldB.KellerA. (2007) Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire. Assessment14: 223–230.
43.
LustmanP. J.ClouseR. E.GriffithL. S.CarneyR. M.FreedlandK. E. (1997) Screening for depression in diabetes using the Beck Depression Inventory. Psychosomatic Medicine59(1): 24–31.
44.
MillerK. E.OmidianP.QuraishyS. A.QuraihsyN.NasiryM. N.NasiryS.YaqubiA. A. (2006) The Afghan Symptom Checklist: A culturally grounded approach to mental health assessment in a conflict zone. American Journal of Orthopsychiatry76(4): 423–433.
45.
MoggaS.AlemA.KebedeD.StewartR.GlozierN.HotopfM. (2006) Outcome of major depression in Ethiopia. British Journal of Psychiatry189: 241–246.
46.
MollicaR. F.Caspi-YavinY.BolliniP.TruongT.TorS.LavelleJ. (1992) The Harvard Trauma Questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and post traumatic stress disorder in refugees. Journal of Nervous and Mental Disease180: 111–116.
47.
MollicaR. F.WyshakG.de MarneffeD.KhuonF.LavelleJ. (1987) Indochinese versions of the Hopkins Symptom Checklist-25: A screening instrument for the psychiatric care of refugees. American Journal of Psychiatry144: 497–500.
48.
NicolasG.DesilvaA. M.SubrebostK. L.Breland-NobleA.Gonzalez-EastepD.ManningN.PraterK. (2007) Expression and treatment of depression among Haitian immigrant women in the United States: Clinical observation. American Journal of Psychotherapy61(1): 83–98.
49.
PatelV.BoyceN.CollinsP.SaxenaS.HortonR. (2011) A renewed agenda for global mental health. Lancet378(9801): 1441–1442.
50.
PatelV.PrinceM. (2010) Global mental health: A new global health field comes of age. The Journal of the American Medical Association303(19): 1976–1977.
51.
PatelV.SimunyuE.GwanzuraF. (1995) Kufungisisa (thinking too much): A Shona idiom for non-psychotic mental illness. Central African Journal of Medicine41(7): 209–215.
52.
PatelV.SimuyuE.GwanzuraF.LewisG.MannA. (1997) The Shona Symptom Questionnaire: The development of an indigenous measure of common mental disorders in Harare. Acta Psychiatrica Scandinavica95: 469–475.
53.
PierreA.MinnP.SterlinC.AnnoualP. C.JaimesA.RaphaëlF.KirmayerL. J. (2010) Culture and mental health in Haiti: A literature review. Santé Mentale en Haïti1(1): 13–42.
54.
PrinceM.PatelV.SaxenaS.MajM.MaselkoJ.PhillipsM. R.RahmanA. (2007) No health without mental health. The Lancet370(9590): 859–877.
55.
RasmussenA.KatoniB.KellerA. S.WilkinsonJ. (2011) Posttraumatic idioms of distress among Darfur refugees: Hozun and majnun. Transcultural Psychiatry48(4): 392–415.
56.
RaviolaG.BeckerA. E.FarmerP. (2011) A global scope for global health—including mental health. The Lancet378(9803): 1613–1615.
57.
RaviolaG. J.EustacheE.OswaldC.BelkinG. (2012) Mental health response in Haiti in the aftermath of the 2010 earthquake: A case study for building long-term solutions. Harvard Review of Psychiatry20: 1–10.
58.
RoseN.HughesP.AliS.JonesL. (2011) Integrating mental health into primary health care settings after an emergency: Lessons from Haiti. Intervention9(3): 211–224.
59.
Smith FawziM. C.BetancourtT.MarcelinL.KloppnerM.MurielA. C.OswaldC.MukherjeeJ. S. (2009) Depression and post-traumatic stress disorder among Haitian immigrant students: Implications for access to mental health services and educational programming. BMC Public Health9: 482–493.
60.
Smith FawziM. C.EustacheE.OswaldC.SurkanP.LouisE.ScanlanF.MukherjeeJ. (2010) Psychosocial functioning among HIV-affected youth and their caregivers in Haiti: Implications for family-focused service provision in high HIV burden settings. AIDS Patient Care and STDs24(3): 147–158.
61.
SterlinC. (2006) Pour une approche interculturelle du concept de santé. Ruptures, revue transdisciplinaire en santé11(1): 112–121.
62.
Van OmmerenM.SharmaB.ThapaS.MakajuR.PrasainD.BhattaraiR.de JongJ. (1999) Preparing instruments for transcultural research: Use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcultural Psychiatry36(3): 285–301.
63.
WagenaarB. H.HagamanA. K.KaiserB. N.McLeanK. E.KohrtB. A. (2012) Depression, suicidal ideation, and associated factors: A cross-sectional study in rural Haiti. BMC Psychiatry12(149): 1–13.
64.
WeobongB.AkpaluB.DokuV.Owusu-AgyeiS.HurtL.KirkwoodB.PrinceM. (2009) The comparative validity of screening scales for postnatal common mental disorder in Kintampo, Ghana. Journal of Affective Disorders113(1–2): 109–117.
65.
World Health Organization (WHO) (2000) WHODAS II Disability Assessment Schedule training manual: A guide to administration, Geneva, Switzerland: Author.
66.
World Health Organization (WHO) (2002) Mental Health Global Action Programme: Close the gap, dare to care, Geneva, Switzerland: Author.
67.
World Health Organization (WHO) (2008) mhGAP: Mental Health Gap Action Programme: Scaling up care for mental, neurological and substance use disorders, Geneva, Switzerland: Author.
68.
World Health Organization (WHO) (2010) mhGAP intervention guide, Geneva, Switzerland: Author.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
